Volunteer Form
Information
The Lycoming County
Society for the Prevention of Cruelty to Animals
2805 Reach Road
Williamsport, Pa. 17701
(570) 322-4646
http://www.lycoming.org/spca
Volunteer Application
Today’s Date ______________
NAME___________________________________________________________________________
ADDRESS________________________________________________________________________
BIRTHDATE_____________________ PHONE__________________________
E-MAIL ADDRESS_________________________________________________________________
If under 18 years of age, NAME OF PARENT or GUARDIAN.
________________________________________________________________________________
PERSON to notify in case of an emergency, include TELEPHONE NUMBER.
________________________________________________________________________________
If employed, NAME OF EMPLOYER and ADDRESS.______________________________________
________________________________________________________________________________
WORK PHONE____________________________________________________________________
Can you be contacted at work? Please check. Yes No Leave message only
If a student or unemployed, please give two references. Include NAME and PHONE.
________________________________________________________________________________________________________________________________________________________________
Are you related to or are you a friend of an SPCA employee or volunteer? Yes No
If YES, please state name and relationship.______________________________________________
Do you have hospitalization insurance? Yes No
Date of your last tetanus vaccination.___________________________________________________
Please tell us about yourself and why you wish to volunteer your services at the Lycoming County SPCA?__________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________
Please tell us about your past or present volunteer experiences.______________________________
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Were you ever or are you now actively involved with any other non-profit, community or religious organizations? Yes No If Yes please list organizations._____________________________
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What is your experience with animal care and handling?____________________________________
________________________________________________________________________________
Do you have any specific skills or training pertaining to the care of pets (i.e. obedience instructor, grooming, or veterinarian, etc.)?_______________________________________________________
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Do you have any outside interests that may enhance the SPCA’s role in the community? (E.g.; photography, advertising, artwork, public relations, arts/crafts, computer skills, medical/health care background or experience, etc.)?______________________________________________________
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Please list any hobbies, skills or extra curricular activities you enjoy.___________________________
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What do you feel are some of your greatest strengths.______________________________________
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As an SPCA volunteer, you are required to commit to a minimum of four to eight hours per month for a minimum of six months to the shelter. Do you feel you are able to make and keep this commitment? Yes No If NO, why not?_____________________________________________
Do you have any situations or health issues the shelter should be aware of? Yes No
If YES, Please explain.______________________________________________________________
________________________________________________________________________________
Have you ever or are you currently involved with the breeding of animals? Yes No
Please explain your opinion on the breeding of pets._______________________________________
________________________________________________________________________________________________________________________________________________________________
Do you understand that the Lycoming County SPCA is an open shelter, that we receive more animals than we have kennel space for, and that we do Euthanize animals? Yes No
Please explain your feelings regarding euthanasia.________________________________________
________________________________________________________________________________________________________________________________________________________________
Please note that volunteer orientation is usually held in January, March, May, July, and September. You will be contacted about one month in advance to schedule an orientation.
In signing this application, I understand and agree to the following:
I agree to abide by the policies and procedures presented to me at the new volunteer orientation and training meeting.
I will maintain confidentiality regarding any and all matters not in the best interest of the animals, their new or previous owners, and/or anything pertaining to the operation of the Lycoming County SPCA.
In the event that I am injured while acting as a volunteer at or for the Lycoming County SPCA, I understand that I am not covered by the Workman’s Compensation Law of Pennsylvania.
I agree to volunteer at least four hours a year in fundraiser events as part of my volunteer duties.
I agree to attend and complete mandatory animal handling training prior to being scheduled to work with shelter animals. The animal handling training will be scheduled approximately two months after attending the new volunteer orientation.
DATE__________ SIGNATURE________________________________________________
For Office Use Only
1. Application Reviewed____________ Approved Yes No If NO, why____________________
2. New Volunteer Orientation Date_____________________________________________________
3. Added E-Mail Address_____________________________________________________________
4. Added Information into Database____________________________________________________
5. Four Hours of Special Events Completed______________________________________________
6. Sunday Morning Training Date______________________________________________________
7. Animal Handling & Training Date____________________________________________________
8. Volunteer Assignment_____________________________________________________________
9. Application Entered into Volunteers’ Spreadsheet_______________________________________
What activities would you like to be involved with? (Check all that apply.)
1. Education-classroom and youth groups. Please circle. Day or Evening __________
2. Pet therapy-nursing home visitations__________
3. Events-fundraisers and community projects__________
4. Office work__________
5. Hands-on with the animals_________
6. Dog walking__________
7. Dog training_________
8. Cat Socialization_________
9. Greeter program__________
Please Read the following statements.
Please initial on the line provided, indicating that you have read and understand the statement.
For the safety of the animal and the community, the Lycoming County SPCA does not adopt out feral cats. These animals are humanely euthanized to prevent them from ending up in an unfortunate situation where they may hurt someone, be hurt or suffer illness. The SPCA does concede that not all of these animals are mean or vicious; however, proper screening and placement of these animals far outweighs our resources as a shelter.
Please initial here._______
I understand the “Volunteer Visitor Policy” in that, I may only bring visitors during NON-Volunteer visits, during normal business hours (when the kennels are open for viewing), and I may only show them around the public areas of the building and may not get animals out of their kennels.
Please initial here._______
I understand the importance of the minimum time commitment; four to eight hours per month, for six months. Should I find the nature of this volunteer work is not what I expected, or, that I cannot complete the minimum hours for any other personal reason, I will inform the Volunteer Coordinator so she may update her records accordingly. I realize this may require me to attend all training AGAIN should I want to volunteer in the future. I understand that I may be terminated from the volunteer program and revoked of certain animal handling privileges should I exhibit an unexplained absence. This too, at the discretion of the Volunteer Coordinator, may require me to attend training again. I understand these policies are in place to ensure volunteers are confidently trained, thus lessening the chances of injury.
Please initial here._______
I understand it is recommended that I have an up to date TETNUS vaccine, in the event that I am bitten or scratched. This is not a requirement to volunteer, but is strongly advised. TETNUS vaccines need to be updated every 10 years. It may be obtained by my physician at my own expense.
Please initial here._______
TO BE COMPLETED AT ORIENTATION
WAIVER: I understand that as a volunteer for the Lycoming County SPCA, I will be working with animals with unknown and unpredictable characteristics and dispositions, and will be subjecting myself to various work conditions. I assume the risk of any injury that may result from my volunteer services at the Lycoming County SPCA. I, the undersigned, hereby release the Lycoming County SPCA, its employees and/or directors from any and all liabilities that may occur during my volunteer time with the shelter. I further acknowledge that I am of sound health and physically able to participate in this volunteer capacity.
_____________________________________ ___________________________________________
(Volunteer Signature) (Parent if Minor) (Witness) (Date)